Surgical Treatment Of Thoracolumbar Fractures Research Articles

Minimally Invasive Surgery for Traumatic Thoracolumbar Fractures: A Cross-Sectional Study of Spine Surgeons

To describe the perceived feasibility of minimally invasive surgical treatment of thoracolumbar fractures among spine surgeons in Latin American centers. This is a cross-sectional study on minimally invasive surgical treatment for unstable thoracolumbar fractures. We conducted an online survey of spine surgeons working in Latin American centers, administered between December 16, 2022 and January 15, 2023. A nonprobabilistic sample was selected (snowball sampling). A questionnaire was sent by email and other messaging applications. Data were extracted from 134 surgeons. The majority of the respondents were from Brazil (n=30, 22.4%), Mexico (n=24, 17.9%), Argentina (n=22, 16.4%), and Chile (n=15, 11.2%). Their mean age was 46.53years (standard deviation, 9.7; range 31-67) and almost all were males (n=128, 95.5%). Most respondents were orthopedists (n=85, 63.4%) or neurosurgeons (n=49, 36.9%). Most of the respondents (n=110, 82.1%) reported at least some difficulty using minimally invasive techniques for thoracolumbar fractures. It should be noted that there were significant regional differences between the surgeons' responses (P=0.017). Chilean surgeons reported better results than others. Spinal surgeons from Latin American centers have identified challenges and obstacles to performing minimally invasive surgery for thoracolumbar trauma. The survey found that a majority of respondents experienced some level of difficulty, with regional variations. The most frequently reported difficulties were the high cost of the procedure, patient insurance restrictions, and long insurance approval times.

Clinical Efficacy and Imaging Observation of Three Surgical Approaches in Treatment of Thoracolumbar Fractures.

To observe the efficacy and imaging of surgical treatment of thoracolumbar fractures via the paravertebral muscle space approach. A retrospective analysis was conducted on patients with thoracolumbar fractures receiving surgery in Baoding First Central Hospital from January 2019 to December 2020. According to different surgical approaches, they were divided into paravertebral approach group, posterior median approach group and minimally invasive percutaneous approach group. They received surgery via the paravertebral muscle space approach, posterior median approach and minimally invasive percutaneous approach, respectively. Statistically significant differences were found in surgical duration, intraoperative bleeding volume, intraoperative fluoroscopy frequency, postoperative drainage volume and hospital stay among the three groups. One year after surgery, the VAS, ADL and JOA scores of the paravertebral approach group and the minimally invasive percutaneous approach group had statistically significant differences from the posterior median approach group (P < 0.05). For the surgical treatment of thoracolumbar fractures, the clinical efficacy of the paravertebral muscle space approach is superior to that of the traditional posterior median approach, and the clinical efficacy of the minimally invasive percutaneous approach is similar to that of the posterior median approach. All the three approaches can effectively improve the postoperative function and pain symptoms of patients without increasing the incidence of complications. Compared with the posterior median approach, the surgery via the paravertebral muscle space and minimally invasive percutaneous approaches presents shorter surgical duration, less bleeding and shorter hospital stay, which is more conducive to postoperative recovery of patients.

Hidden blood loss between percutaneous pedicle screw fixation and the mini-open Wiltse approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: a retrospective study

BackgroundThe aim of this study was to determine the proportion of hidden blood loss (HBL) in patients treated with minimally invasive surgery, and to compare the HBL between patients treated with percutaneous pedicle screw fixation (PPSF) and the mini-open Wiltse approach with pedicle screw fixation (MWPSF).MethodsFrom January 2017 to January 2019, a total of 119 patients with thoracolumbar fractures were included in the analysis, of which 58 cases received PPSF and 61 cases received MWPSF. The clinical information and demographic results were collected and compared. And the HBL of the patients is calculated by the combination formulas of Nadler, Gross and Sehat.ResultsCompared with the PPSF group, operation time of MWPSF is shorter. The fluoroscopy times are 13.6 ± 3.0 in PPSF group and 5.6 ± 1.6 in MWPSF group (p < 0.001). As shown in Table 3, the intraoperative blood loss in PPSF group is 31.9 ± 9.6 ml, which is significantly less than that in the MWPSF group (44.0 ± 14.9 ml). The HBL (445.7 ± 228.9 ml), and HBL% (91.2 ± 7.7%) of the PPSF group are significantly higher than that in the MWPSF group (P < 0.05). And the total blood loss (TBL) of the PPSF group (477.6 ± 228.8 ml) is also more than that in the MWPSF group (401.0 ± 171.3 ml).ConclusionsOur results suggest that in the minimally invasive surgical treatment of thoracolumbar fractures, the perioperative HBL is much higher than visible blood loss (VBL). Although PPSF has less intraoperative blood loss, it has higher TBL and HBL than those of MWPSF. Compared with MWPSF, we should pay more attention to the postoperative anemia status of patients with thoracolumbar fractures undergoing PPSF surgery.

Early Surgical Treatment of Thoracolumbar Fractures With Thoracolumbar Injury Classification and Severity Scores Less Than 4.

Thoracolumbar fractures (TLFs) are the most common spinal fractures seen in patients with trauma. The Thoracolumbar Injury Classification and Severity (TLICS) classification system is commonly used to help clinicians make more consistent and objective decisions in assessing the indications for surgical intervention in patients with thoracolumbar fractures. Patients with TLICS scores <4 are treated conservatively, but a percentage of them will have failed conservative treatment and require surgery at a later date. All patients who received an orthopaedic consult between January 2016 and December 2020 were screened for inclusion and exclusion criteria. For patients meeting the study requirements, deidentified data were collected including demographics, diagnostics workup, and hospital course. Data analysis was conducted comparing length of stay, time between first consult and surgery, and time between surgery and discharge among each group. 1.4% of patients with a TLICS score <4 not treated surgically at initial hospital stay required surgery at a later date. Patients with a TLICS score <4 treated conservatively had a statistically significant shorter hospital stay compared with those treated surgically. However, when time between initial consult and surgery was factored into the total duration of hospital stay for those treated surgically, the duration was statistically equivalent to those treated nonsurgically. For patients with a TLICS score <4 with delayed mobilization after 3 days in the hospital or polytraumatic injuries, surgical stabilization at initial presentation can decrease the percentage of patients who fail conservative care and require delayed surgery. Patients treated surgically have a longer length of stay than those treated conservatively, but there is no difference in stay when time between consult and surgery was accounted for. In addition, initial surgery in patients with delayed mobilization can prevent long waits to surgery, while conservative measures are exhausted. Retrospective cohort study.

Surgical treatment of thoracolumbar fracture in ankylosing spondylitis: A comparison of percutaneous and open techniques

Background contextPosterior percutaneous long-segment internal fixation and open fixation with long-segment screws have been used to treat thoracolumbar fractures in ankylosing spondylitis patients.PurposeTo observe the clinical effect of posterior percutaneous long-segment internal fixation in 26 ankylosing spondylitis (AS) patients with thoracolumbar fractures.Study designRetrospective cohort study.Patient sampleForty-seven AS patients who were diagnosed with thoracolumbar fractures and treated from December 2014 to December 2018.Outcome measuresVisual analog scale score, Cobb angle, American Spinal Injury Association Grade, SF-Qualiveen score, pedicle screw misplacement rate, operative duration, blood loss, complications, bed rest duration and modified MacNab score.MethodsAll patients were divided into the percutaneous group (PG) and the open group. Twenty-six patients were treated with percutaneous long-segment internal fixation, and the remaining 21 underwent open fixation with long-segment screws. The minimum follow-up period was 12 months.ResultsThe operations were successful in both groups. A patient in the PG showed class C wound healing, while the others showed class A healing, and some patients experienced perioperative complications. All patients were followed up for 12–48 months (mean, 33.81 months), and all patients showed clinical osseous fracture healing. Significant differences were found in operative duration, intraoperative blood loss and postoperative bed rest duration between the two groups (P < 0.05). No significant difference was found in improvement of the visual analog scale score, Cobb angle of spinal kyphosis or neurological function after the operation (P > 0.05).ConclusionsAs a minimally invasive procedure, posterior percutaneous long-segment internal fixation requires less time, results in less blood loss and causes less trauma. This procedure can also improve patients’ pain, neurological function and kyphotic deformity and achieve effects similar to those of traditional methods. With this curative clinical effect, this procedure can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients, especially for elderly patients with underlying diseases and high surgical risk.

Effectiveness of Percutaneous Pedicle Screw Fixation for Traumatic Thoracolumbar Spine Fracture

Introduction: Surgical treatment of thoracolumbar fracture without neurological damage has resulted in better clinical and radiological outcome than conservative treatment. Traditional open approach is associated with extensive paravertebral muscle damage and postoperative morbidity so percutaneous pedicle screw fixation is highly valuable alternatives.&#x0D; Aims: to evaluate the efficacy and outcome of percutaneous pedicle screw fixation in the treatment of traumatic thoracolumbar fracture without neurological deficit.&#x0D; Methods: This study was conducted in Nepalgunj Medical College, Nepalgunj in a time span of one year; total of 40 patients were included and treated with percutaneous pedicle screw fixation and followed up for 6months. They were evaluated clinically and radiologically.&#x0D; Results: 40 patients with thoracolumbar fractures were managed with percutaneous pedicle screw fixation with a mean operative time of 77.30 min and intraoperative blood loss was 88.38ml. There was significant improvement in cobb’s angle (mean difference 13.92 degree), vertebral body height loss (mean difference 37.7%) and visual analogue scale (mean difference 3.55) postoperatively. These improvements remained statically significant at 6months follow up.&#x0D; Conclusion: Percutaneous pedicle screw fixation is safe, valid and effective treatment of thoracolumbar fracture without neurological deficit.

Surgical Techniques for Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations.

To formulate the specific guidelines for the recommendation of thoracolumbar fracture regarding surgical techniques and nonfusion surgery. WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meeting. For nonfusion surgery and thoracolumbar fracture, a systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020. The search was further refined by excluding the articles which were duplicate, not in English or were based on animal or cadaveric subjects. After thorough shortlisting, only 50 articles were selected for full review in this consensus meeting. To generate a consensus, the levels of agreement or disagreement on each item were voted independently in a blind fashion through a Likert-type scale from 1 to 5. The consensus was achieved when the sum for disagreement or agreement was ≥ 66%. Each consensus point was clearly defined with evidence strength, recommendation grade, and consensus level provided. A magnitude of prospective papers were analyzed to formulate consensus on various surgical techniques that can be employed to address different types of thoracolumbar fractures. Surgical treatment of thoracolumbar fractures can be a better option over the nonoperative approach, especially for those who cannot tolerate months in an orthosis or cast, such as those with multiple extremity injuries, skin lesions, obesity, and so forth. It generally allows early mobilization, less hospital stay, reduced pulmonary complications, and better correction of sagittal balance. Current available literature fails to demonstrate any statistically significant benefit of fusion surgery over nonfusion in thoracolumbar fractures.

Clinical application of Orthopedic Tianji Robot in surgical treatment of thoracolumbar fracture

To explore the clinical application of Orthopedic Tianji Robot in the treatment of thoracolumbar fractures with minimally invasive percutaneous pedicle screw internal fixation. The clinical data of 46 patients with thoracolumbar fractures treated by minimally invasive percutaneous pedicle screw internal fixation from June 2018 to January 2020 in Gansu Provincial People's Hospital was retrospectively analyzed. According to the different aided equipments, the patients were divided into a C-arm X-ray plus robot assisted nail placement group (observation group) and simple C-arm X-ray assisted nail placement group (control group). Twenty-two patients in observation group, including 12males and 10 females, aged from 24 to 61 years old, with a mean of(40.23±12.19) years, 3 cases were T11 vertebrae fracture, 8 cases were T12, 9 cases were L1, and 2 cases were L2. And there were 24 cases in control group, including 15 males and 9 females, aged from 26 to 58 years old, with a mean of (42.88±10.31) years, 3 cases were T11 vertebrae fracture, 10 cases were T12, 7 cases were L1, and 4 cases were L2. The operation time, the number of intraoperative fluoroscopy, intraoperative blood loss, the days of hospitalization, and postoperative complications were recorded. Preoperative and postoperative VAS at 3 days, 1 week and 3 months were compared between two groups. The sagittal Cobb angle of the injured vertebral body and the percentage of the anterior edge height of the vertebral body were observed before and after operation, and evaluate the accuracy of nail placement according to the Gertzbein-Robbins classification criteria with collected postoperative CT images. All patients were followed up for 5 to 12 months with an average of (7.07±0.83) months. There was no significant differences in intraoperative blood loss, operation time and hospitalization days between two groups (P>0.05). The number of intraoperative fluoroscopy was (5.62±0.51) times in observation group and (12.54±0.52) in control group, the difference between two groups was statistically significant (P<0.05). The VAS, the percentage of the height of the injured vertebra anterior edge and the Cobb angle of the injured vertebral plane at each time point after operation were improved(P<0.05), but the difference between two groups was not statistically significant (P>0.05). One case of postoperative incision infection occurred in the control group, which was cured after active dressing changes. There were no serious complications such as screw loosening and breakage in all patients, and there was no statistically significant difference in the incidence of complications between two groups(P>0.05). The postoperative nail placement accuracy ratesof the observation group and the control group were 98.4% (126/128) and 90.3% (121/134), respectively, and the difference was statistically significant (P<0.05). In the surgical treatment of thoracolumbar fractures, compared with simple C-arm fluoroscopy, the pedicle screw placement assisted by Orthopedic Tianji Robot overcomes the shortcomings of surgeon's physiological tremor, fatigue and multiple intraoperative fluoroscopy, improves the accuracy of screw placement, and is a more accurate and safer way of pedicle screw placement for thoracolumbar fractures.

Evaluation of long-term surgical treatment outcomes of thoraco-lumbar spinal fractures - follow-up period of over 10 years.

Agricultural accidents often result in spinal injuries, particularly in fractures of the thoraco-lumbar spine. Surgical treatment of thoraco-lumbar fractures continues to comprise a major medical problem. The aim of this study was to assess and compare the long-term effects of surgical treatments of thoracic and lumbar spinal fractures treated with transpedicular stabilization, combined with posterior interbody spinal fusion (PLIF, also known as spondylodesis) or Daniaux reconstruction. A retrospective analysis was conducted on 66 patients with a thoracic or lumbar spinal fracture (Th10-L3) type A in the AO classification system, operated in 2000-2005. All patients underwent a short segment transpedicular stabilization, which in 36 patients was combined with posterior interbody spinal fusion, and in 30 other patients combined with Daniaux reconstruction. Radiological assessment was performed based on X-ray imaging. A lateral X-ray image of the spine was used to measure the vertebral wedging angle of the fractured vertebrae, the height ratio of the anterior to posterior vertebral body, and the angle of segmental kyphotic deformation. Subjective long-term assessment of the patient was conducted using the Oswestry Instability Score. The results were analyzed for statistical significance. In both groups, similar improvements in all measured parameters were observed. Despite all patients losing some of the correction in the long-term, this loss was significantly smaller following Daniaux reconstruction. Spinal stabilization combined with vertebral reconstruction allows for long-term and improved treatment results for thoraco-lumbar fracture than posterior interbody spinal fusion (spondylodesis).

Surgical treatment of traumatic thoracolumbar fractures: a retrospective review of 101 cases.

To evaluate the outcomes of vertebral stabilisation after acute traumatic thoracolumbar fractures, correlating the outcome with patient clinical data, type and location of fracture, presence of neurological damage, timing of surgical intervention and number of instrumented levels. The results have been evaluated also through the AO classification and AOSIS score. Retrospective analysis of 101 patients with traumatic thoracolumbar injuries from T3 to L5 operated 2011-2016 by posterior or antero-posterior fixation. The demographic data, trauma dynamics, number and type of fractures, associated lesions, timing of surgery, hospital stay, AOSIS score, RKA, SF-36 and ODI scores, pre- and post-operative neurological condition (ASIA grade), possible complications and re-interventions were evaluated for each patient. Fractures mainly involved the region between T11 and L2. The probability of medullary involvement increases with the increase in severity of the main fracture type with no relation with the vertebral region. Type B and C fractures were common in the thoracic region and rare in the thoracolumbar junction. ODI and SF-36 scores were significantly better in patients with a lower AOSIS score, specifically in lesions classified as type A, amyelic and with no comorbidity. No difference was found in the clinical scores between thoracic, thoracolumbar and lumbar fractures, nor between male and female patients. None of the 10 patients with ASIA A lesion at presentation achieved any degree of recovery: 50% of them had a thoracic lesion. Re-intervention rate was 15%. Hospital stay was significantly higher in patients with type C fractures, and complication rate was on average 14% (7% in type A fractures, 16% in B and 25% in C). This study confirmed the validity of the posterior approach in the surgical treatment of thoracolumbar fractures. Outcomes and complication risks are related to fracture severity. Surgical treatment can be recommended even with an AOSIS score of two or three. The combined antero-posterior approach could be useful in cases with LSC > 8, especially in the thoracolumbar region. The degree of neurological recovery depends on fracture type, location, ASIA score and presence of comorbidities. Early intervention in myelic patients allows for a better prognosis. Level of evidence III retrospective case series.

NUMERICAL ANALYSIS OF SHORT AND LONG INSTRUMENTATION IN THE TREATMENT OF THORACOLUMBAR FRACTURES CONSIDERING THE LIGAMENTOUS PORTION

ABSTRACT Objective: This study aims to numerically evaluate the surgical treatment of thoracolumbar fractures, comparing the strengths between the long and short fixations using the pedicle of the fractured vertebra, taking into account the supraspinous, intertransverse, and anterior longitudinal ligaments. Methods: A numerical analysis of the techniques of long and short fixation of a thoracolumbar spine fracture was performed using computed tomography images that were converted into three-dimensional models and analyzed through the ANSYS program. The two types of treatments were analyzed considering the tensions generated in the immediate postoperative period, when the fracture has not yet been consolidated. The anterior, posterior, supraspinal and intertransverse longitudinal ligaments were added, in addition to considering different vertebral geometries. Results: Taking into account that the maximum tensile stress of the material used in the metal implant, in the case of titanium, was 960 MPa, the highest tension found in the analysis of the short instrumentation was 346.83 MPa, reaching only 36.13% of the load the material supports, being, therefore, within a safety limit. The analysis performed in the spine with long instrumentation showed the highest tension value of 229.22 MPa. Conclusions: Considering the values found and the resistance of the synthesis material used, the short and long fixation can be considered in the treatment of thoracolumbar fractures with similarity and a good safety coefficient. Level of Evidence III; Case-Control.

Hot issues in diagnosis and treatment of thoracolumbar fractures

In recent years, the surgical treatment of thoracolumbar fractures has made great progress. The thoracolumbar injury classification and severity score (TLICS) of thoracolumbar injuries and the new AO classification, as the most widely used classification score in clinical application, have a clear guiding significance for clinical treatment and scientific research. With the extensive application of CT and MRI, the divergence in the diagnosis of posterior ligament complex (PLC) injury in scoring systems has been narrowed. With the wide application of pedicle screw and the deeper understanding of the anatomical and mechanical characteristics of spine, posterior pedicle screw fixation has been gradually adopted as the major method, while anterior or posterior pedicle screw fixation is only used in special cases. Because of the in-depth study of pedicle screw mechanics, more and more attention has been paid to the fixation of injured vertebrae. Moreover, with the intensive study of sagittal balance of the spine, the reconstruction of injured vertebrae has been proposed as a new concept and further investigated. The author discusses thoracolumbar fracture scoring system, surgical approach, surgical fixation segment, bone graft reconstruction and minimally invasive treatment so as to provide some reference. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae

Research progress of surgical treatment of thoracolumbar fractures

Research progress of surgical treatment of thoracolumbar fractures

Radiological Results of Treatment of Thoracolumbar Fractures with Bony Failure of the Posterior Tension Band by Percutaneous Pedicle Fixation

Introduction Currently, we have multiple options for surgical treatment of thoracolumbar fractures. Among these, percutaneous pedicle fixation raises several advantages, particularly in terms of reduced soft tissue injury and the ability to recover motion segments in cases with consolidation potential as type B1 and some type B2 fractures. Our objective is to analyze the radiological results of treatment of these fractures by percutaneous pedicle fixation and the preservation of motion segments after implant removal. Patients and Methods Prospective, observational, and descriptive study of radiological follow-up case series of patients with thoracolumbar spine fractures with bony failure of the posterior tension band and without neurological involvement treated by percutaneous pedicle fixation surgery. Radiological results were evaluated by measurement of preoperative regional kyphosis, correction achieved, correction preservation, bone healing, and recovery of mobile segments post removal of fixation. For statistical analysis, the Student t test for paired samples was used. Results A total of 13 patients, 12 men and 1 woman, with a mean age of 40 years. Overall, five type B1 and eight type B2 fractures between T9 and L2. Fixation for two levels was performed in all of them. An average correction of 8 degrees ( p = 0.0036), reaching normal levels in 10 patients was achieved. At 6 months' follow-up, loss of correction was observed in all patients. The average loss was 7 degrees ( p = 0.0021), a regional kyphosis remained within the normal range in eight patients. Consolidation was observed at 8 months' follow-up in all the patients. Material removal was performed in seven patients. Of these, five had a preservation of mobility within normal ranges. No intra- or postoperative complications occurred. Overall, two patients had partial loosening of the fixation system. Conclusion Percutaneous pedicle fixation presents an effective alternative in treating thoracolumbar fractures with the bony failure of posterior tension band with consolidation potential. The results in our experience are comparable to those described for both minimally invasive and traditional techniques. The possibility of removal of material for preserving mobile levels presents an important advantage compared with techniques involving fusion.

Surgical Treatment of Thoracolumbar Fractures with Osteosynthesis

Introduction The aim of this study is to describe the results obtained in 44 patients, all between 20 and 65 years, operated between 2011 and 2013 with the diagnosis of thoracic and lumbar vertebral fractures posttraumatic, treated in our department. In all cases, we used the same technique, which consists of fixing two levels above and two levels below the fractured vertebrae including it in the osteosynthesis system getting full or partial reduction of the fracture. After the fracture consolidation, we proceeded to the removal of the implant between 6 to 9 months after surgery. The indication was always surgical treatment with temporary fixation without arthrodesis. After the removal of the osteosynthesis material, all patients recovered the capacity of flexo-extension of the thoracolumbar spine. The patients returned to their previous levels of daily life and sport. It took them 35 days on an average to return to work and from 6 to 9 months to their sports activities. Patients were followed for 1 year after surgery. Patients and Methods A total of 44 patients were evaluated, 34 men and 10 women. The complaint was for posttraumatic back or low back pain by falls from their own height standing or sitting, in the 72% of cases, with no more than 48 hours of evolution that did not get better with rest and got worse with mobilization. The rest of the cases were traffic accidents. All patients were studied by MRI and X-rays. All fractures were treated by the same surgeon within the first 72 hours of making the diagnosis. Fractures were divided as follows: D9 (1 case), D10 (7 cases), D11 (6 cases), D12 (11 cases), L1 (10 cases), L2 (7 cases), L3 (1 case) and L4 (1 case). Overall, 83% of cases were type A fractures according to the AO classification, and the remaining 17% were type B, which were associated with rupture of the posterior wall and invasion of the spinal canal. Only two fractures had neurological and motor compromise C, according to Frenkel classification. The rest of the fractures had Frenkel E. Results All patients returned to their usual physical activities, even those who played sports with the exception of the two Frenkel C. As postoperative complications, patients had scar hygromas that were cured with puncture and compressive bandage. Everyone referred complete or partial improvement of their symptoms. Only in one case, we had a postoperative complication which was the rupture of one of the lower transpedicular screws of the system at 3 months; after the removal of the implant at 6 months, the pain disappeared without complications. Conclusion This method, temporary fixation without arthrodesis of five levels, is usually used in our department to treat thoracolumbar fractures. Patients had no postoperative complications except one patient who presented a ruptured of a transpedicular screw but no reoperation was needed. In all cases, there was a complete remission of symptoms and return to normal activity.

Surgical Treatment of Thoracolumbar Fractures:Anterior Versus Posterior Approach

Background Data: Treatment of thoracolumbar vertebral fractures is highly controversial. The most important factor determining treatment strategy is whether the patient has a neurological injury. Purpose: This work studied the results of the surgical treatment of thoracolumbar fractures admitted at the Neurosurgery Department of Benha University Hospitalbetween January 2006 and June 2014 and tried to outline the indications of either the anterior or the posterior approach based on this experience. Study Design: Descriptive retrospective clinical case study. Patients and Methods: This is a retrospective study of the medical records of 72 patients who were hospitalized with the diagnosis of traumatic thoracolumbar spinal fracture and operated upon at the neurosurgical department of Banha University between January2006 and June 2014. Sixty patients operated through the anterior approach, where 12 operated through the anterior approach. Results: Clinical outcome: Posterior group: no patient experienced neurological deterioration postoperatively. Preoperative low back/leg pain improved greatly in most patients (54 out of 60) and remained the same in 6 patients based on the VAS for pain. Anterior group: According to ASIA; patients grade A (N=6) and D (N=1), remained thesame post-operatively, whereas, of the other patients with incomplete cord lesion (N=5), three improved one grade and two did not improve at the last follow-up. Radiological outcome: Posterior group: Preoperatively, most patients experienced loss of more than 40% of the vertebra body’s height and compromise of more than 40% in canal. Its overallmean values were 42.5±11.5% and 50.6±10.2%, respectively. No statistically significant correlation appeared between the canal compromise and loss of vertebral body height (P>0.05). However, the mean kyphotic deformities measured preoperatively and at within 12 months follow-up, were 19.2±5.5 degrees and 8.0±3.6 degrees. The meanmid-sagittal diameter improved from 9.2±3.1 mm before surgery to 15.1±0.8 mm at the 12 months follow-up visit, with a significant difference between preoperative and postoperative values (P<0.01). The mean vertebral body height before surgery was 42.5±11.5%. At the 12-month follow-up visit, this score showed a statistically significant increase, to 69.0±11.4% (P<0.01). Anterior group: The preoperative segmental kyphosis improved postoperatively (at the three month follow up visit) from a mean of 26.5o (range 16- 35o) to a mean of 11o (range 5- 17o). This correction was maintained in all but three patients who lost correction of a mean 3o (at the end of the follow up visits- at 12 months). None of the patients had implant failure. All patients had bone fusion on final follow up plain radiography. Conclusion: Posterior surgery is performed primarily in the treatment of burst fractures without neurological deficit. Anterior decompression is indicated in an incomplete neurologic deficit with marked canal compromise and intact posterior ligamentous complex. Both approaches are safe and efficient in retaining the stability of the spine. (2014ESJ071)

Interspinous H-shaped bone grafting and bilateral facet interbody fusion for prevention of delayed kyphosis after surgical treatment of thoracolumbar fracture

Objective To evaluate the clinical effect of interspinous H-shaped bone grafting and bilateral facet interbody fusion in treatment of thoracolumbar fracture with severe disc injury and posterior ligamentous complex (PLC) injury after posterior pedicle screw fixation and its role in prevention of delayed kyphosis.Methods The study involved 19 cases of thoracolumbar fractures with severe disc injury and PLC injury,including 11 males and 8 females,at age of 23-59 years (mean 43.8 years.All cases were treated with posterior pedicle screw fixation (including 11 cases treated with unilateral laminectomy decompression) and C-arm X-ray showed favorable fracture reduction.For prevention of postoperative delayed kyphosis,the interspinous H-shaped bone grafting plus bilateral facet interbody fusion by using the iliac autografts was done.Neurologic recovery was assayed by using Frankel scale and lumbar and iliac pain by visual analogue scale (VAS).Cobb angle was detected as well.Results All cases were followed up for 24-64 months.At final follow-up,all cases showed neurological improvement for at least 1 to 2 Frankel grades except for two cases with Frankel Grade A,with mean Cobb angle of (2.0 ± 3.7) ° (range,-4.9°-8.1 °),mean VAS of lower back pain of (1.1 ± 1.2) points (range,0-4 points) and insignificant angle loss or kyphosis.The thin layer CT scan indicated complete integration of the transplanted bone grafts,with no complications like implant loosening or breakage.Conclusion Interspinous H-shaped bone grafting and bilateral facet interbody fusion is a good choice for prevention of delayed kyphosis after posterior pedicle screw fixation of thoracolumbar fracture with severe disc injury and PLC injury. Key words: Spinal fractures ; Fracture fixation ; Correction loss ; Bone grafting

Association of clinical parameters of operatively treated thoracolumbar fractures with quality of life parameters

The intention of the current work was to assess the association between clinical parameters and seven different quality of life (QoL) instruments after surgical treatment of thoracolumbar spinal fractures after an average follow-up of 4.2years. The following human-related quality of life and PRO measures of 66 patients were correlated to clinical parameters such as fingertip-to-floor distance (FFD), Schober measurement, pressure and percussion pain in the lumbopelvine area (PPP), and paravertebral muscle tension: reALOS, SF-36, VAS, VAS spine score, BDI, the GBB-24, and the IES-R. Overall, there was a significant association between the clinical parameters of the thoracolumbar spine such as PPP, paravertebral muscle tension, FFD and Schober's sign on one side, and the seven tested instruments on the other side. PPP and FFD as well as a small Schober measurement are clinical parameters which significantly influence QoL after surgical treatment of thoracolumbar fractures.

Retrospective Comparison of H-graft and Posterior Vertebral Graft Procedures for the Treatment of Thoracolumbar Burst Fractures

A retrospective cohort study was conducted to compare fusion rates achieved by H-grafts, posterior vertebral grafts, and no graft for the surgical treatment of thoracolumbar fractures. Ninety-two patients were included in this study. The patients fell into 1 of 3 groups: those who received H-grafts (n=36), posterior vertebral grafts (n=30), and no graft (n=26). Mean follow-up was 38 months (range, 24-51 months). All operations were performed by a single senior surgeon. All patients underwent operative treatment with posterior reduction and instrumentation. Radiographic parameters, estimated blood loss, operative time, and length of hospital stay were compared among patients in the 3 graft groups. Differences were assessed using unpaired t tests. P values <.05 were considered significant. We found no significant difference among groups in age, fracture location, or type of fracture. Patients who received H-grafts or posterior vertebral grafts achieved solid fusion, but spontaneous fusion occurred in only 2 patients who received no bone graft. Most patients with neurological deficits showed significant neurological improvement. Operative time and estimated blood loss were significantly lower in the no-graft group than in the H-graft and posterior vertebral graft groups (P<.05). Mean loss of correction, operative time, and estimated blood loss were lower for patients who received H-grafts than for those who received posterior vertebral grafts (P<.05). The use of an atlas fixation system in combination with a posterior H-graft for the treatment of thoracolumbar fracture is a stable and reliable method that effectively prevents inner fixation failure and reduces bone loss and anisotropy.

External Spinal Skeletal Fixation Combination With Percutaneous Injury Vertebra Bone Grafting in the Treatment of Thoracolumbar Fractures

A technical report of thoracolumbar fractures managed by percutaneous external pedicular fixation and intracorporeal bone grafting. To develop a new technique by combining simplified percutaneous external pedicular fixator with intracorporeal bone grafting to treat thoracolumbar fractures and assess its technical safety and clinical efficacy. For surgical treatment of thoracolumbar fractures, the classical techniques are beneficial in decompression, restoration, fixation, and graft fusion, but they are also hugely invasive procedures. The earlier external spinal fixation procedures are good at indirect restoration, decompression, and elastic fixation of spinal fracture. However, they are limited by remains of a large external frame and inability of vertebral reconstruct. Therefore, the minimally invasive techniques combining simplified percutaneous external pedicular fixation and intracorporeal bone grafting might be a useful alternative. There were 50 consecutive patients who had thoracolumbar fractures with or without associated incomplete neurologic deficit. They underwent percutaneous external pedicle fixation and intracorporeal bone grafting surgery within 7 days of admission, had their implants removed after 3 months, and were prospectively followed for at least 12 months. American Spine Injury Association grading, spinal canal encroachment, spinal Cobb angle, and vertebral body height were calculated before and after surgery to assess clinical outcome. A minimum of 12-month follow-up was achieved in 50 patients. The average operative time was 90 minutes (range, 50-160 minutes). The mean bone graft volume was 4.8 cm (range, 3.2-10.6 cm). The intraoperative mean blood loss was 100 mL (range, 50-180 mL). Forty-two patients all had at least one American Spine Injury Association grade neurologic improvement on final follow-up observation; there were no surgery-related complications. The mean anterior height of vertebral body was 53.2% (range 25%-78%) before surgery, 93.6% (range 78%-104%) after surgery, and 94% (range 79%-103%) at final follow-up. The preoperative Cobb angle of the primary curve averaged 30.7° (range 8°-67°), and corrected to 4.5° (range 0°-12.0°) immediately after surgery, There were statistically significant (P < 0.01) among them before and after operation. There was no instrumentation failure or measurable loss of sagittal curve and vertebral height correction in any cases. The new technique by combination of percutaneous external transpedicular fixation and transpedicular bone grafting is a feasible, safe, useful, efficient, and minimally invasive method to treat thoracolumbar fractures. It is a reasonable alternative method to other minimally invasive techniques of surgical management of the thoracolumbar fractures.